Background: Peer-assisted learning (PAL) is the development of knowledge and skill through active help and support of equals. However, this has not been tested in medical education in India. Objectives: To assess the effectiveness of PAL on improvement in cognitive assessment scores and its acceptance among undergraduate medical students in one public teaching medical university in North India. Methodology: After approval from the Institutional Ethics Committee, three PAL sessions, 1 per week, each on specific topic, were conducted using small group discussion methodology with a faculty contact and student leader and 4-6 peer-learners, in 9 th semester MBBS students. A pretest with multiple choice questions (MCQs) was followed by distribution of learning objectives and list of resource material. PAL session was conducted after 72 h, followed by posttest by MCQs and then focus group discussion (FGD) on students' experiences. Results: Of the 26 students enrolled, three PAL sessions was completed by 22 (84.6%) students. The correlation coefficient between pre- and post-test scores was 0.48 (P < 0.0001), with a 24.2% improvement in posttest scores. In the nine FGDs most said that PALs helped in the better preparation of the topic, clarifying doubts, lessened examination anxiety, improved communication skills, and increased self-confidence. Conclusion: PAL was well accepted, and it improved assessment scores. Therefore, it can be adopted for teaching selected topics across all subjects of MBBS course.

Context: Basic medical sciences and clinical teachings are not coordinated in the present medical education system. They are not taught keeping in mind the outcomes required at the time of actual handling of patients in the community. Aims: An educational development project was implemented in the Department of Pathology with the aim that it will result in the student learning to link the pathophysiology of the disease to clinical scenarios and become fully competent for lifelong medical practice. Subjects and Methods: The pathology teaching of the second professional batch was modified by starting with defining the desired outcomes/competencies in the student's knowledge, skills, and attitude which were then addressed by lectures, demonstrations, practical classes and small group activities where case scenarios and laboratory reports were included. The outcome was assessed by Objectively Structured Clinical/Practical Examination and multiple choice questions. Force field analysis, faculty and student interviews, and questionnaires were used to assess the factors affecting its implementation and impact. Results: Totally 80 students of the 2 nd Professional MBBS were exposed to a competency-based education development project. It was found that the system was appreciated by faculty and students, especially the integration with clinical scenarios. There were many factors which influenced the execution of this program, including motivation level of students and faculty, time, logistics and meticulous planning. Conclusions: There was a significant improvement in student's performance and satisfaction. Many factors including prior planning were a major determinant for the success of this education development project.

Context: Students should be exposed to early clinical scenario so that they start developing competency-based learning right from their MBBS 1 st year. Medical Council of India has recognized this need and has suggested early clinical exposure of MBBS 1 st year students in their document Vision 2015. Medical education in India needs change for achieving desired competencies. It has been concluded that Indian medical undergraduates have inadequate knowledge in cardiopulmonary resuscitation (CPR). Aims: To implement CPR workshop in MBBS 1 st year, and to study the impact of CPR workshop among MBBS 1 st year students. Design: Interventional study. Materials and Methods: CPR workshop was conducted with the help of Faculty of Anesthesia and Physiology among MBBS 1 st year students. Teaching learning methods employed were lecture, demonstration, and hand-on practice on mannequin in small groups. The evaluation was done by pre- and post-standardized, validated questionnaire; direct observation procedural skill, and feedback questionnaire. Results: There was a significant improvement in knowledge of students as shown from results of pre- and post-questionnaire. About 84.24% students found the presentation excellent, 71.23% students found the demonstration excellent in terms of visibility and clarity, 63.7% students found the instructions excellent. All students were successful in acquiring skills of CPR as shown by results of directly observed procedural skills. Conclusions: Results of this study suggest that the workshop provided students with sound basic knowledge and adequate practical skills in CPR. CPR workshop should be carried out every year among undergraduate students. CPR workshop should be introduced in MBBS 1 st year curriculum.

Background: Lecture is a common traditional method for teaching, but it may not stimulate higher order thinking and students may also be hesitant to express and interact. The postgraduate (PG) students are less involved with undergraduate (UG) teaching. Team based small group active learning method can contribute to better learning experience. Aim: To-promote active learning skills among the UG students using small group teaching methods involving PG students as facilitators to impart hands-on supervised training in teaching and managerial skills. Methodology: After Institutional approval under faculty supervision 92 UGs and 8 PGs participated in 6 small group sessions utilizing the jigsaw technique. Feedback was collected from both. Observations: Undergraduate Feedback (Percentage of Students Agreed): Learning in small groups was a good experience as it helped in better understanding of the subject (72%), students explored multiple reading resources (79%), they were actively involved in self-learning (88%), students reported initial apprehension of performance (71%), identified their learning gaps (86%), team enhanced their learning process (71%), informal learning in place of lecture was a welcome change (86%), it improved their communication skills (82%), small group learning can be useful for future self-learning (75%). Postgraduate Feedback: Majority performed facilitation for first time, perceived their performance as good (75%), it was helpful in self-learning (100%), felt confident of managing students in small groups (100%), as facilitator they improved their teaching skills, found it more useful and better identified own learning gaps (87.5%). Conclusions: Learning in small groups adopting team based approach involving both UGs and PGs promoted active learning in both and enhanced the teaching skills of the PGs.

Context: Various alternative methods are being used in many medical colleges to reinforce didactic lectures in physiology. Small group teaching can take on a variety of different tasks such as problem-solving, role play, discussions, brainstorming, and debate. Research has demonstrated that group discussion promotes greater synthesis and retention of materials. Aims: The aims of this study were to adopt a problem-solving approach by relating basic sciences with the clinical scenario through self-learning. To develop soft skills, to understand principles of group dynamics, and adopt a new teaching learning methodology. Subjects andMethods: Experimental study design was conducted in Phase I 1 st year medical students of 2014-2015 batch (n = 120). On the day of the session, the students were grouped into small groups (15 each). The session started with the facilitator starting off the discussion. Feedback forms from five students in each group was taken (n = 40). A five point Likert scale was used ranging from strongly agree to strongly disagree. Data were analyzed using IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp. Results: Our results show that 70% of the students opined that small group discussion were interactive, friendly, innovative, built interaction between teacher and student. Small group discussion increased their thought process and helped them in better communication. Conclusions: The small group discussion was interactive, friendly, and bridged the gap between the teacher and student. The student's communication skills are also improved. In conclusion, small group discussion is more effective than the traditional teaching methods.

Context: The knowledge of pharmacology is an important necessity for the prevention and treatment of diseases. The study aimed to find out the beneficial effects of case-based learning (CBL) compare to didactic lecture in pharmacology and to evaluate the perceptions of students regarding the CBL. Methods: A total of 68 students took part in the study and were randomly assigned to two equal groups: Group 1 (CBL group) and Group 2 (lecture group). Cases, test items, students feedback questionnaires were developed and peer viewed by experts. Group 1 underwent the CBL and the same topics were handled as a didactic lecture in Group 2 concurrently. Written tests were conducted after completion of each session and the perceptions of students were evaluated. Results: The Group 1 showed significantly increased (P < 0.001) test score in knowledge-based and critical thinking (clinical application) as compared to Group 2. The perceptions of students were quite positive regarding the CBL as a majority revealed that they has better understanding of concepts (82.35%), self-learning approach (91.17%), critical thinking with integration clinical subjects (97.05%), and active participation in discussion (76.47%) as well as interest in subject (88.24%) through the CBL process. Conclusion: Self-learning approach, critical thinking with the integration of subject, and arousal of interest in the subject were positive effects of CBL in the teaching of concepts of pharmacology.

Background: At present, in a medical school, students are taught in different departments, subject-wise, without integration to interrelate or unify subjects and these results in compartmentalization of medical education, with no stress on case-based learning. Therefore, an effort was made to develop and adopt integrated teaching in order to have a better contextual knowledge among students. Methodology and Implementation: After the faculty orientation training, four "topic committees" with faculty members from different departments were constituted which decided and agreed on the content material to be taught, different methodologies to be used, along with the logical sequencing of the same for the purpose of implementation. Different teaching methodologies used, during the program, were didactic lectures, case stimulated sessions, clinical visits, laboratory work, and small group student's seminar. Results: After the implementation of program, the comparison between two batches as well as between topics taught with integrated learning program versus traditional method showed that students performed better in the topics, taught with integrated approach. Students rated "clinical visits" as very good methodology, followed by "case stimulated interactive sessions." Students believed that they felt more actively involved, and their queries are better addressed with such interactive sessions. Conclusion: There is a very good perception of students toward integrated teaching. Students performed better if they are taught using this technique. Although majority of faculty found integrated teaching, as useful method of teaching, nevertheless extra work burden and interdepartmental coordination remained a challenging task.

Background: Although lecture handouts are commonly given to students during theory lectures, students' perception, as well as their performance, can vary depending on the type of handouts they receive for information processing. Methodology: This is a quasi-experimental study involving 6 th semester medical students. The study was conducted during theory lectures on ophthalmology. The two types of notes given to the students were comprehensive handout and a skeleton handout, which included some lecture notes but required substantial annotation by the students. Pre-test and post-test in the form of multiple choice questions were conducted before and after the lecture session, respectively. Results: There was a significant difference of mean score of pre- and post-test between skeletal handout (pre = 1.85 ± 1.275, post = 4.85 ± 0.363) and full handout (pre = 1.92 ± 1.09 post = 2.61 ± 0.771) with P < 0.001. However, the students' responses to questionnaires indicated a strong preference for much detailed handouts as essential to preparation for examinations. Conclusion: The student can improve their performance during examination while working on skeletal handouts during theory lectures in spite of showing a preference for complete handouts.

The usefulness of Mini Clinical Evaluation Exercise as a learning tool in different pediatric clinical settings

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Atul Goel, Tejinder SinghDOI:10.4103/2229-516X.162266 PMID:26380207

Background: Mini Clinical Evaluation Exercise (Mini-CEX), have been an underutilized tool for the formative assessment in India. Not many studies have been done in India to examine its feasibility and acceptability in residency programs of most clinical subjects. Aim: To assess the feasibility and acceptability of Mini-CEX in different pediatric clinical settings and to know if it helped the residents with improved learning. Methods: Pediatric residents were regularly evaluated with Mini-CEX over a period of 1 year by standard methodology. Each encounter was followed by case specific feedback given to the residents. Several such encounters were held in different pediatric clinical settings like pediatric outpatient departments (POPDs), pediatric wards, Pediatric Intensive Care Unit (PICU), Neonatal Intensive Care Unit (NICU), etc. By the end of the year, both teachers and residents were asked to give feedback on 5 point Likert scale based on their experience with the exercise. Results: The entire exercise was participated by 11 teachers and 23 residents. Mini-CEX encounters were conducted in POPDs 38%, pediatrics ward 22%, PICU 19%, NICU 15%, and casualty 6%. The overall average score for all students was 5.65. An average improvement in scores by 1.9 points was observed over a period of 1 year all students and teachers felt that the exercise was feasible in most pediatric clinical settings. Students accepted that the feedback given by the teachers well and accepted that this feedback helped them with improved learning. Conclusions: Residents and teachers, both considered Mini-CEX as a feasible exercise. Residents accepted that the feedback after each exercise helped them in their learning.

Context: Student evaluation of faculty is an essential part of the academic process. The study was designed to compare two formats of student evaluation of teachers (SETs) with a view to determine the method with minimum bias. Aims: To compare student ratings of teacher effectiveness obtained from two different SET formats and determine factors contributing to the student bias. Materials and Methods: Faculty members of first professional were evaluated by MBBS students using a SET-I questionnaire already in use. Faculty perceived types of bias were documented using a separate semi-structured questionnaire. Based on this, a second SET-II questionnaire with Likert scale was designed and filled out by the same students as before. The faculty was apprised of the scores granted to them, and their acceptance of the preferred SET format was determined with the help of another questionnaire. Results: Ratings obtained from 71 students using both the SET-I and SET-II formats showed no difference. However, the level of students satisfaction with teacher effectiveness, compared with the total teacher score, indicated that when a score of the faculty was below 50%, the level of students satisfaction reduced considerably. The major causes of perceived negative bias identified were strictness, seniority, gender, classes taken, less interest in the subject, and lower student grades. SET-II was preferred by faculty but didn't eliminate all bias factors. Conclusions: Although it was not possible to remove all causes of bias from the modified student questionnaire, the faculty perception of bias affecting the students rating seems to be largely ungrounded as there was no difference between the scores obtained.

Context: There is ample evidence to prove that medical graduates are not prescribing rationally and this can be improved by proper training. Aims: To design and implement a prescription writing teaching module for second professional medical students. SubjectsandMethods: A module of 3 h duration consisting of didactic lecture, interactive audiovisual small group session, and evaluation method was framed for every disease and implemented. Completeness of the prescriptions was evaluated on a scale of 1-4. Appropriateness of the prescription, knowledge about the rationale behind the drugs used and adverse events related to the drugs used was judged in three categories, that is, appropriate and complete; appropriate but insufficient; and inappropriate. Results: One thousand six hundred and seven response sheets to 24 health problems were collected. Completeness score of 18% was 2, 59% was 3% and 24% was 4.41% prescriptions were appropriate and complete, 58% appropriate but insufficient and 1% inappropriate. The rationale behind the drugs used was appropriate and complete 24%, appropriate but insufficient 68%, inappropriate 8%. Documentation of adverse events was appropriate and complete 23%, appropriate but insufficient 49%, inappropriate 28%. All facilitators were satisfied with the duration, contents and conduct of the sessions. Conclusions: A module is an effective tool for teaching prescription writing to undergraduate students; modifications required in contents and strategy to emphasize the need of complete documentation.

Introduction: Like many other people based professions, communications skills are essential to medical practice also. Traditional medical teaching in India does not address communication skills which are most essential in dealing with patients. Communication skills can be taught to medical students to increase clinical competence. Objective: To teach basic communication and counseling skills to fourth-year undergraduate students to increase their clinical competence. Methodology: A total of 48, fourth-year MBBS students participated in the study. They were given training in basic communication and counseling skills and taught the patient interview technique according to Calgary-Cambridge guide format. Improvement in communication was assessed by change in pre- and post-training multiple choice questions, clinical patient examination, and Standardized Patient Satisfaction Questionnaire (SPSQ) scores. ResultsandAnalysis : About 88% of the students in the sample were convinced of the importance of learning communication skills for effective practice. Almost 90% students were communicating better after training, as tested by improved SPSQ. As judged by Communication Skill Attitude Scale, student's positive attitude toward learning communication skill indicated that there is a necessity of communication skill training during undergraduate years. Conclusion: The ability to communicate effectively is a core competency for medical practitioners. Inculcating habits of good communications skill during formative years will help the medical students and future practitioners. Regular courses on effective communication should be included in the medical school curriculum.

Context: Problem-based learning (PBL) is a methodology widely used in medical education and is growing in dental education. Initiation of new ideas and teaching methods requires a change in perception from faculty and institute management. Student-centered education is a need of the day and PBL provides the best outlet to it. Aim: To introduce PBL, assess feasibility and challenges in undergraduate dentistry program and evaluate the impact on their learning. Settings and Design: PBL was used as a teaching methodology on 37 students in 2 nd year BDS program. The PBL was duplicated as that of MBBS program. PBL was spread over 5 days. Pre- and post-test questions along with different questionnaires were designed for the students and tutors/faculty to be administered after PBL session. Subjects and Methods: Case with temporomandibular joint and muscles of mastication and occlusion was designed as a module with five triggers given to students who were divided into five groups over two tutorials facilitated by tutor. Resource sessions were held by involved departments (Oral Biology, Oral Pathology, Oral Medicine and Radiology, Orthodontics, and Oral Surgery). Students were allotted time for search, research and discover to search literature. Statistical Analysis Used: Descriptive statistics. Results: Pre and post-test comparison showed that the knowledge increased immensely following PBL sessions. Students' assessment by tutors following two PBL tutorials showed a mean score of 34.9 ± 4.01 and 35.5 ± 3.86, respectively. Students' feedback showed that most of them preferred PBL because they found it interactive, collaborative, goal and research oriented. Students were motivated to learn new topic because learning objectives were formulated by themselves and they developed self-directed learning skills. The tutors learned to design cases. Conclusions: PBL encouraged students to use more interactive methods of learning which possibly will make them lifelong learners.

Evaluation of orientation program for fresh MBBS entrants: Faculty and students' perspectives

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Rajiv Mahajan, Kapil GuptaDOI:10.4103/2229-516X.162278 PMID:26380212

Context: One-day orientation program (OP) for fresh MBBS entrants is running in our institute since 2010, but has never been evaluated. Aims and Objectives: To evaluate the OP from students' and faculty perspectives and to recommend a revised program. Methodology: Totally 439 students of three MBBS batches were enrolled in the study. Students were asked to fill an anonymous semi-structured, pretested questionnaire. Views of faculty members were recorded by conducting three focus group discussions. Results: More than half of the students have never attended the institutional OP due to timings issue. Overall rating of the program was good, but many students and faculty members suggested changes in the duration, timings and course content of the OP. A revised OP was proposed to the authorities. Conclusion: The current institutional program though rated good, requires a lot of amendments. The revised proposed OP should be implemented from the coming session.

Context: We believe that there is significant educational deficit amongst interns regarding up-to-date formal knowledge and skills on healthcare-associated infections (HAIs) which might compromise patient safety. This urgently requires curriculum innovations to ensure their formal training on HAIs prevention and control. Aim : Education of interns to improve their knowledge and skills toward HAIs prevention and control. SubjectsandMethods: This pilot study was conducted in interns using a multimodal approach consisting of a combination of videos, PowerPoint presentation, and hands-on demonstration to provide applied and practical teaching on prevention and control of HAIs. Pre- and post-test assessment of knowledge, attitude, and skills was carried out by multiple choice questions, 5-point Likert scale, and Objective Structured Practical Examination respectively. StatisticalAnalysisUsed: Paired t-test Results: A statistically significant improvement in the overall score rates between pre- and post-test of intern's was seen, suggesting that educational programs have a positive effect. Intern's felt benefitted from interventions focused on HAIs prevention and control and hoped that such sessions are integrated in the regular undergraduate curriculum. A majority of the students felt that their learning style assessment matched well with their own perception of learning preference. Conclusions: Assessment drives learning; hence strengthening the contribution of health-care workers to HAIs prevention programs should include measures that enhance knowledge, improve skills and develop appropriate attitudes, resulting in safety and quality of patient care.

Background: Individualization of instructional method does not contribute significantly to learning outcomes although it is known that students have differing learning styles (LSs). Hence, in order to maximally enhance learning, one must try to use a mixed method approach. Hypothesis: Our hypothesis was that awareness of preferred LS and motivation to incorporate multiple learning strategies might enhance learning outcomes. Aim: Our aim was to determine the impact of awareness of LS among medical undergraduates and motivating students to use mixed methods of learning. Materials and Methods: Before awareness lecture, LS preferences were determined using Visual, Aural, Read/Write, and Kinesthetic (VARK) questionnaire. Awareness of LS was assessed using a validated questionnaire. Through a lecture, students were oriented to various LSs, impact of LS on their performance, and benefit of using mixed method approach for learning. Subsequently, group discussions were organized. After 3 months, VARK preferences and awareness of LSs were reassessed. Student narratives were collected. Qualitative analysis of the data was done. Results: There was a significant increase in the number of students who were aware of LS. The number of participants showing a change in VARK scores for various modalities of learning was also significant (P < 0.001). Conclusion: Thus, awareness of LSs motivated students to adapt other learning strategies and use mixed methods for learning.

Context: One of the most important factors of medical education that can revolutionize the learning process in postgraduate students (PGs) is assessment for learning by means of formative assessment (FA). FA is directed at steering and fostering learning of the students by providing feedback to the learner. However, though theoretically well suited to postgraduate training, evidence are emerging that engaging stakeholders in FA in daily clinical practice is quite complex. Aims: To explore perceptions of PGs and teachers (Ts) about factors that determines active engagement in FA. Subjects and Methods: It was a descriptive qualitative study involving focus group discussions (FGDs) with PGs and Ts from Departments of Pediatrics and Orthopedics. FGDs data were processed through points/remarks, data reduction, data display, coding followed by theme generation for content analysis. Results: Four higher order themes emerged: Harsh reality of present summative assessment structure, individual perspectives on feedback, supportiveness of the learning environment, and the credibility of feedback and/or feedback giver. Conclusions: Engaging in FA with a genuine impact on learning is complex and quite a challenge to both students and Ts. Increased acceptability along with the effective implementation of FA structure, individual perspectives on feedback, a supportive learning environment and credibility of feedback are all important in this process. Every one of these should be taken into account when the utility of FA in postgraduate medical training is evaluated.

Context: Despite a radical shift in assessment methodologies over the last decade, the majority of medical colleges still follow the Traditional Practical Examination (TPE). TPE raises concerns about examiner variability, standardization, and uniformity of assessment. To address these issues and in line with the notion of assessments as motivating what and how students learn, Objectively Structured Practical Examination (OSPE) was introduced, as an assessment modality. Despite its usefulness, awareness and motivation to use the same, still needs to be probed. Aims: To implement OSPE in the assessment of practical skills in biochemistry, and to know student and faculty perspectives regarding OSPE. SettingsandDesign: OSPE was introduced at the stage of formative assessment of practical skills, for 94 year one MBBS students. SubjectsandMethods: Students were divided into two groups; the first group was evaluated by the traditional method and the second by OSPE. Students were crossed over on a second examination. The mean score obtained by both the methods was compared statistically. Students and faculty perspectives regarding OSPE were obtained by a questionnaire. Student performance was compared using "Bland-Altman technique," and Student's t-test. Results: The mean scores of students was found to be significantly higher (P < 0.0001) when assessed with OSPE as compared to TPE. Number of students achieving >70% marks was also significantly higher with OSPE. Validity was supported by a significant correlation coefficient of comparison of marks by the two methods. Feedback from students and faculty indicated that they endorsed OSPE. Conclusions: This evaluation demonstrated the need for a structured approach to assessment. Going in line with the notion that assessment drives learning, introducing OSPE would help tailoring teaching-learning to optimize student satisfaction and learning.

Context / Background: Written examinations are the most commonly employed method for assessment of cognitive skills in medical education. The few disadvantages of essay questions are less number of questions, limited sampling, unfair distribution of questions over topics, vague questions etc., Blueprinting overcomes these issues, increasing the validity of examinations. Objectives: To describe the process of developing a blueprint for undergraduate written examinations in pathology; and to evaluate its effect as a tool to increase the content validity of assessment. Methodology: A workshop was conducted in the Department of Pathology to sensitize the faculty about the importance of blueprinting. A blueprint was prepared for written examinations in pathology, question papers were set accordingly and administered in preliminary examinations. Feedback was collected from the students and faculty to know their perceptions about the question papers with reference to blueprinting. Results: The students and faculty felt that there was appropriate distribution of questions across topics (77% and 89%, respectively), appropriate weightage given to topics of public health importance (65% and 100%), examinations were fair (86% and 89%). All the faculty felt that blueprints aligns assessment with objectives and helps as a guide and to paper construction. Conclusions: Students were satisfied as blueprinting helped them to attempt examination better. The faculty who validated the blueprint felt that it helps in distribution of appropriate weightage and questions across the topics and blueprinting should be an integral part of assessment.